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Highlights
• Proteomic analyses of submandibular gland extracts of two alligator lizards of the Anguidae family are reported.
• A conserved set of putative toxins was found in the submandibular gland extracts of Abronia lythrochila and A. graminea.
• Toxins evolved in oral secretions of paleo- and neoanguimorpha over more than 100 million years of Anguimorpha cladogenesis.
• Electron microscopy of pleurodont teeth of A. lythrochila showed no sign of groove, external opening or striations.
• Assessing the role toxins play in the ecology of extant anguimorph lizards deserves functional studies in natural prey.
Abstract
A useful approach to deepen our knowledge about the origin and evolution of venom systems in Reptilia has been exploring the vast biodiversity of this clade of vertebrates in search of orally produced proteins with toxic actions, as well as their corresponding delivery systems. The occurrence of toxins in anguimorph lizards has been demonstrated experimentally or inferred from reports of the toxic effects of the oral secretions of taxa within the Varanidae and Helodermatidae families. In the present study, we have focused on two alligator lizards of the Anguidae family, the Mexican alligator lizard, Abronia graminea, and the red-lipped arboreal alligator lizard, A. lythrochila. In addition, the fine morphology of teeth of the latter species is described. The presence of a conserved set of proteins, including B-type natriuretic peptides, cysteine-rich secretory proteins, group III phospholipase A2, and kallikrein, in submandibular gland extracts was demonstrated for both Abronia species. These proteins belong to toxin families found in oral gland secretions of venomous reptile species. This finding, along with previous demonstration of toxin-producing taxa in both paleo- and neoanguimorpha clades, provides further support for the existence of a handful of conserved toxin families in oral secretions across the 100+ million years of Anguimorpha cladogenesis.
Introduction: Patients undergoing left atrial appendage closure (LAAC) are often severly anemic and close to the transfusion threshold. The aim was to investigate the prevalence of severe anemia in this cohort and if procedural safety is compromised compared with non-anemic patients.
Methods and results: Comparison of severly anemic patients (Hb < 80 g/l) vs. non-severly anemic patients in the prospective, multicentre observational LAARGE registry of patients undergoing LAAC. A total of 638 patients (anemia 22.3% vs non-anemic 77.7%) were included. Anemic patients were older (77.1 years ± 7.9 vs 75.6 years ± 7.9, p = 0.014), had more comorbidities, higher CHA2DS2-VASc (4.8 vs 4.4, p = 0.017) and higher HAS-BLED (4.3 vs 3.8, p < 0.001) scores. Implant success was not influenced by anemia (99.3% vs 97.2%). Severe in-hospital (0.7% vs 5.6%, p = 0.01) and overall complications (8.5% vs 13.7%, p = 0.11) were less common in patients with anemia, driven by fewer pericardial effusions. Mortality was higher in anemic patients and associated with an increased hazard ratio, albeit not significantly (16.0% vs 10.3%, HR 1.61 (95%-CI: 0.97–2.67), p = 0.06). In the one-year follow-up, composite outcome of death, stroke or systemic embolism occurred in 22/142 anemic and in 54/496 non-anemic patients with an adjusted HR of 1.04 (95%-CI 0.62–1.73, p = 0.89).
Conclusion: Severe anemia close to the transfusion threshold is common in patients undergoing LAAC. However, this does not influence in-hospital complications or implant success. One-year mortality is higher in anemic patients, mainly driven by co-morbidities.
Key Teaching Points
• Wearables such as smartwatches can monitor beyond heart rate and heart rhythm.
• Specific smartwatches provide reliable measurements of electrocardiographic intervals (eg, QT interval).
• Correct analysis and interpretation of the QT interval in an individual with previously unknown long QT syndrome facilitated the diagnosis.
Aim: The aim of this study was to evaluate the relationship between coronary artery calcification (CAC) assessed by multi-detector computed tomography (MDCT) and myocardial perfusion assessed by cardiac magnetic resonance imaging (CMR) in a group of symptomatic patients.
Method: Retrospective analysis of 120 patients (age 65.1 ± 8.9 years, 88 males) who presented with atypical chest pain to Bethanien Hospital, Frankfurt, Germany, between 2007 and 2010 and who underwent CAC scoring using MDCT, CMR, and conventional coronary angiography. Patients were divided into those with high-grade (HG) stenosis (n = 67, age 65.1 ± 9.4 years) and those with no-HG stenosis (n = 53, age 65.1 ± 8.6 years).
Results: There were more males with HG stenosis (82.1% vs. 62.3%, p = 0.015), in whom the percentage and number of abnormal perfusion segments were higher at rest (37.3% vs. 17%, p = 0.014) but not different with stress (p = 0.83) from those with no-HG stenosis. Thirty-four patients had myocardial perfusion abnormalities at rest and 26 patients developed perfusion defects with stress. Stress-induced myocardial perfusion defects were 22.4% sensitive and 79.2% specific for detecting HG stenosis. The CAC score was lower in patients with no-HG stenosis compared to those with HG stenosis (p < 0.0001). On the ROC curve, a CAC score of 293 had a sensitivity of 71.6% and specificity of 83% in predicting HG stenosis [(AUC 0.80 (p < 0.0001)]. A CAC score of 293 or the presence of at least 1 segment myocardial perfusion abnormality was 74.6% sensitive and 71.7% specific in detecting HG stenosis, the respective values for the 2 abnormalities combined being 19.4% and 90.6%. The severity of CAC correlated with the extent of myocardial perfusion in the patient group as a whole with stress (r = 0.22, p = 0.015), particularly in those with no-HG stenosis (r = 0.31, p = 0.022). A CAC score of 293 was 31.6% sensitive and 87.3% specific in detecting myocardial perfusion abnormalities.
Conclusion: In a group of patients with exertional angina, coronary calcification is more accurate in detecting high-grade luminal stenosis than myocardial perfusion defects. In addition, in patients with no stenosis, the incremental relationship between coronary calcium score and the extent of myocardial perfusion suggests coronary wall hardening as an additional mechanism for stress-induced angina other than luminal narrowing. These preliminary findings might have a clinical impact on management strategies of these patients other than conventional therapy.
Rationale and Objectives: Lumbar disk degeneration is a common condition contributing significantly to back pain. The objective of the study was to evaluate the potential of dual-energy CT (DECT)-derived collagen maps for the assessment of lumbar disk degeneration.
Patients and Methods: We conducted a retrospective analysis of 127 patients who underwent dual-source DECT and MRI of the lumbar spine between 07/2019 and 10/2022. The level of lumbar disk degeneration was categorized by three radiologists as follows: no/mild (Pfirrmann 1&2), moderate (Pfirrmann 3&4), and severe (Pfirrmann 5). Recall (sensitivity) and accuracy of DECT collagen maps were calculated. Intraclass correlation coefficient (ICC) was used to evaluate inter-reader reliability. Subjective evaluations were performed using 5-point Likert scales for diagnostic confidence and image quality.
Results: We evaluated a total of 762 intervertebral disks from 127 patients (median age, 69.7 (range, 23.0–93.7), female, 56). MRI identified 230 non/mildly degenerated disks (30.2%), 484 moderately degenerated disks (63.5%), and 48 severely degenerated disks (6.3%). DECT collagen maps yielded an overall accuracy of 85.5% (1955/2286). Recall (sensitivity) was 79.3% (547/690) for the detection of no/mild lumbar disk degeneration, 88.7% (1288/1452) for the detection of moderate disk degeneration, and 83.3% (120/144) for the detection of severe disk degeneration (ICC = 0.9). Subjective evaluations of DECT collagen maps showed high diagnostic confidence (median 4) and good image quality (median 4).
Conclusion: The use of DECT collagen maps to distinguish different stages of lumbar disk degeneration may have clinical significance in the early diagnosis of disk-related pathologies in patients with contraindications for MRI or in cases of unavailability of MRI.
Highlights
• Early reconstruction of injured cruciate ligaments improves functional outcomes.
• Modern CT imaging can be used to rapidly identify patients with injury to the cruciate ligaments and streamline therapeutic pathways.
• Dual-energy CT demonstrates superior diagnostic accuracy compared to single-energy CT.
Abstract
Background: This study aimed to evaluate the clinical utility of modern single and dual-energy computed tomography (CT) for assessing the integrity of the cruciate ligaments in patients that sustained acute trauma.
Methods: Patients who underwent single- or dual-energy CT followed by 3 Tesla magnetic resonance imaging (MRI) or knee joint arthroscopy between 01/2016 and 12/2022 were included in this retrospective, monocentric study. Three radiologists specialized in musculoskeletal imaging independently evaluated all CT images for the presence of injury to the cruciate ligaments. An MRI consensus reading of two experienced readers and arthroscopy provided the reference standard. Diagnostic accuracy parameters and area under the receiver operator characteristic curve (AUC) were the primary metrics for diagnostic performance.
Results: CT images of 204 patients (median age, 49 years; IQR 36 – 64; 113 males) were evaluated. Dual-energy CT yielded significantly higher diagnostic accuracy and AUC for the detection of injury to the anterior (94% [240/255] vs 75% [266/357] and 0.89 vs 0.66) and posterior cruciate ligaments (95% [243/255] vs 87% [311/357] and 0.90 vs 0.61) compared to single-energy CT (all parameters, p <.005). Diagnostic confidence and image quality were significantly higher in dual-energy CT compared to single-energy CT (all parameters, p <.005).
Conclusions: Modern dual-energy CT is readily available and can serve as a screening tool for detecting or excluding cruciate ligament injuries in patients with acute trauma. Accurate diagnosis of cruciate ligament injuries is crucial to prevent adverse outcomes, including delayed treatment, chronic instability, or long-term functional limitations.
Highlights
• Assessment of coronary artery plaque burden according to the CAC-DRS Score correlated well with pulmonary involvement of SARS-CoV-2 pneumonia (min. r=0.81, 95% CI 0.76 to 0.86).
• Visual and quantitative CAC-DRS Score of coronary artery plaque burden provided independent prognostic information on all-cause mortality in patients with SARS-CoV-2 pneumonia (p=0.0016 and p<0.0001, respectively).
• Incorporating CAC-DRS Score and pulmonary involvement into clinical decision making revealed great potential to discriminate patients with fatal outcomes from a mild course of disease (AUC 0.938, 95% CI 0.89 to 0.97) and the need for intensive care treatment (AUC 0.801, 95% CI 0.77 to 0.83).
Purpose: To assess and correlate pulmonary involvement and outcome of SARS-CoV-2 pneumonia with the degree of coronary plaque burden based on the CAC-DRS classification (Coronary Artery Calcium Data and Reporting System).
Methods: This retrospective study included 142 patients with confirmed SARS-CoV-2 pneumonia (58 ± 16 years; 57 women) who underwent non-contrast CT between January 2020 and August 2021 and were followed up for 129 ± 72 days. One experienced blinded radiologist analyzed CT series for the presence and extent of calcified plaque burden according to the visual and quantitative HU-based CAC-DRS Score. Pulmonary involvement was automatically evaluated with a dedicated software prototype by another two experienced radiologists and expressed as Opacity Score.
Results: CAC-DRS Scores derived from visual and quantitative image evaluation correlated well with the Opacity Score (r=0.81, 95% CI 0.76-0.86, and r=0.83, 95% CI 0.77-0.89, respectively; p<0.0001) with higher correlation in severe than in mild stage SARS-CoV-2 pneumonia (p<0.0001). Combined, CAC-DRS and Opacity Scores revealed great potential to discriminate fatal outcomes from a mild course of disease (AUC 0.938, 95% CI 0.89-0.97), and the need for intensive care treatment (AUC 0.801, 95% CI 0.77-0.83). Visual and quantitative CAC-DRS Scores provided independent prognostic information on all-cause mortality (p=0.0016 and p<0.0001, respectively), both in univariate and multivariate analysis.
Conclusions: Coronary plaque burden is strongly correlated to pulmonary involvement, adverse outcome, and death due to respiratory failure in patients with SARS-CoV-2 pneumonia, offering great potential to identify individuals at high risk.
Background: Dual-energy CT (DECT)-derived bone mineral density (BMD) of the distal radius and other CT-derived metrics related to bone health have been suggested for opportunistic osteoporosis screening and risk evaluation for sustaining distal radius fractures (DRFs).
Methods: The distal radius of patients who underwent DECT between 01/2016 and 08/2021 was retrospectively analyzed. Cortical Hounsfield Unit (HU), trabecular HU, cortical thickness, and DECT-based BMD were acquired from a non-fractured, metaphyseal area in all examinations. Receiver-operating characteristic (ROC) analysis was conducted to determine the area under the curve (AUC) values for predicting DRFs based on DECT-derived BMD, HU values, and cortical thickness. Logistic regression models were then employed to assess the associations of these parameters with the occurrence of DRFs.
Results: In this study, 263 patients (median age: 52 years; interquartile range: 36–64; 132 women; 192 fractures) were included. ROC curve analysis revealed a higher area under the curve (AUC) value for DECT-derived BMD compared to cortical HU, trabecular HU, and cortical thickness (0.91 vs. 0.61, 0.64, and 0.69, respectively; p <.001). Logistic regression models confirmed the association between lower DECT-derived BMD and the occurrence of DRFs (Odds Ratio, 0.83; p <.001); however, no influence was observed for cortical HU, trabecular HU, or cortical thickness.
Conclusions: DECT can be used to assess the BMD of the distal radius without dedicated equipment such as calibration phantoms to increase the detection rates of osteoporosis and stratify the individual risk to sustain DRFs. In contrast, assessing HU-based values and cortical thickness does not provide clinical benefit.
Rationale and Objectives: Bone non-union is a serious complication of distal radius fractures (DRF) that can result in functional limitations and persistent pain. However, no accepted method has been established to identify patients at risk of developing bone non-union yet. This study aimed to compare various CT-derived metrics for bone mineral density (BMD) assessment to identify predictive values for the development of bone non-union.
Materials and Methods: CT images of 192 patients with DRFs who underwent unenhanced dual-energy CT (DECT) of the distal radius between 03/2016 and 12/2020 were retrospectively identified. Available follow-up imaging and medical health records were evaluated to determine the occurrence of bone non-union. DECT-based BMD, trabecular Hounsfield unit (HU), cortical HU and cortical thickness ratio were measured in normalized non-fractured segments of the distal radius.
Results: Patients who developed bone non-union were significantly older (median age 72 years vs. 54 years) and had a significantly lower DECT-based BMD (median 68.1 mg/cm3 vs. 94.6 mg/cm3, p < 0.001). Other metrics (cortical thickness ratio, cortical HU, trabecular HU) showed no significant differences. ROC and PR curve analyses confirmed the highest diagnostic accuracy for DECT-based BMD with an area under the curve (AUC) of 0.83 for the ROC curve and an AUC of 0.46 for the PR curve. In logistic regression models, DECT-based BMD was the sole metric significantly associated with bone non-union.
Conclusion: DECT-derived metrics can accurately predict bone non-union in patients who sustained DRF. The diagnostic performance of DECT-based BMD is superior to that of HU-based metrics and cortical thickness ratio.
We can see an increasing consumption of meat together with the corresponding behavioral adaptations in early hominins, such as Homo erectus. This new development was driven by one or more behavioral adaptations, such as a shift to a higher-quality diet, increased social interactions and/or changes in the life history strategies. The methods by which these hominins obtained meat—through scavenging the carcasses of large herbivores or hunting themselves—remain a topic of debate. They seem to have thrived in expanding grasslands, which offered few resources except for herds of large, gregarious mammals. In our study, we developed an agent-based model that simulates the behavior of a group of hunter-gatherers foraging in a reconstructed tropical grassland environment. The environmental parameters, including plant availability and prey population densities, are derived from the Serengeti National Park. In this model, agents gather or hunt various species either alone or as a group, using strategies early hominins may already have access to. The basic behavior and the implemented hunting strategies are based on data from recent hunter-gatherer societies living in tropical grasslands. Our model demonstrates how foragers may have thrived in tropical grasslands by either adopting fast hunting strategies, which often require access to sophisticated hunting tools, or by cooperating extensively, which would rely on an enhanced social structure to promote cooperative behavior. Our model can be used to study other scenarios by offering the option to change the environmental conditions and aspects of the agent behavior.
Abstract
In serial dependence, perceptual decisions are biased towards stimuli encountered in the recent past. Here, we investigate whether and how serial dependence is affected by the availability of visual working memory (VWM) resources. In two experiments, participants reproduced the orientation of a series of stimuli. On alternating trials, we included an additional VWM task with randomly varying levels of load. Serial dependence was not only affected by the additional load task but also clearly modulated by the level of load: a high load in the previous trial reduced serial dependence while a high load in the present increased it. These results were independent of the effects of VWM load on the precision of reproduction responses. Our findings provide new insights into the mechanisms that may regulate serial dependence, revealing its intimate link with VWM resources.
Significance statement
Our perception, thoughts, and behavior are continuously influenced by recent events. For instance, the way we process and understand current visual information depends on what we have seen in the preceding seconds, a phenomenon known as serial dependence. The precise mechanisms and factors involved in serial dependence are still unclear. Here, we demonstrated that working memory resources are a crucial component. Specifically, when we are currently experiencing a heavy memory load, the influence of prior stimuli becomes stronger. Conversely, when prior stimuli were shown under a high memory load, their influence was reduced. These findings highlight the importance of working memory resources in shaping our interpretation of the present based on the recent past.
The branching fraction of D+→K0Sπ0e+νe is measured for the first time using 7.93 fb−1 of e+e− annihilation data collected at the center-of-mass energy s√=3.773~GeV with the BESIII detector operating at the BEPCII collider, and is determined to be B(D+→K0Sπ0e+νe) = (0.881 ± 0.017stat. ± 0.016syst.)\%. Based on an analysis of the D+→K0Sπ0e+νe decay dynamics, we observe the S-wave and P-wave components with fractions of fS-wave = (6.13 ± 0.27stat. ± 0.30syst.)% and fK¯∗(892)0 = (93.88 ± 0.27stat. ± 0.29syst.)\%, respectively. From these results, we obtain the branching fractions B(D+→(K0Sπ0)S-wave e+νe) = (5.41 ± 0.35stat. ± 0.37syst.)×10−4 and B(D+→K¯∗(892)0e+νe) = (4.97 ± 0.11stat. ± 0.12syst.)\%. In addition, the hadronic form-factor ratios of D+→K¯∗(892)0e+νe at q2=0, assuming a single-pole dominance parameterization, are determined to be rV=V(0)A1(0)=1.43 ± 0.07stat. ± 0.03syst. and r2=A2(0)A1(0)=0.72 ± 0.06stat. ± 0.02syst.
In this paper, we construct a Dynamic Stochastic General Equilibrium (DSGE) model to examine the implications of dual rates for green lending. We demonstrate that implementing a distinct interest rate for banks engaged in green lending can effectively mitigate transition risks while channeling more capital towards green production sectors and firms for an immediate cut of emissions and net zero emission economy targets.
Biological drug substance (DS) is typically stored frozen to increase stability. However, freezing and thawing (F/T) of DS can impact product quality and therefore F/T processes need to be controlled. Because active F/T systems for DS bottles are lacking, freezing is often performed uncontrolled in conventional freezers, and thawing at ambient temperature or using water baths.
In this study, we evaluated a novel device for F/T of DS in bottles, which can be operated in conventional freezers, generating a directed air stream around bottles. We characterized the F/T geometry and process performance in comparison to passive F/T using temperature mapping and analysis of concentration gradients. The device was able to better control the F/T process by inducing directional bottom-up F/T. As a result, it reduced cryo-concentration during freezing as well as ice mound formation. However, freezing with the device was dependent on freezer performance, i.e. prolonged process times in a highly loaded freezer were accompanied by increased cryo-concentrations. Thawing was faster compared to without the device, but had no impact on concentration gradients and was slower compared to thawing in a water bath.
High-performance freezers might be required to fully exploit the potential of directional freezing with this device and allow F/T process harmonization and scaling across sites.
Using (2712±14) × 106 ψ(2S) events collected with the BESIII detector at the BEPCII collider, we search for the decays ηc(2S)→ωω and ηc(2S)→ωϕ via the process ψ(2S)→γηc(2S). Evidence of ηc(2S)→ωω is found with a statistical significance of 3.2σ. The branching fraction is measured to be B(ηc(2S)→ωω)=(5.65±3.77(stat.)±5.32(syst.))×10−4. No statistically significant signal is observed for the decay ηc(2S)→ωϕ. The upper limit of the branching fraction at the 90\% confidence level is determined to be B(ψ(2S)→γηc(2S),ηc(2S)→ωϕ)<2.24×10−7. We also update the branching fractions of χcJ→ωω and χcJ→ωϕ decays via the ψ(2S)→γχcJ transition. The branching fractions are determined to be B(χc0→ωω)=(10.63±0.11±0.46)×10−4, B(χc1→ωω)=(6.39±0.07±0.29)×10−4, B(χc2→ωω)=(8.50±0.08±0.38)×10−4, B(χc0→ωϕ)=(1.18±0.03±0.05)×10−4, B(χc1→ωϕ)=(2.03±0.15±0.12)×10−5, and B(χc2→ωϕ)=(9.37±1.07±0.59)×10−6, where the first uncertainties are statistical and the second are systematic.
Highlights
• Piriform cortex and amgydala can be separated based on their distinct structural connectivity.
• Similar to histological findings, the connectivity of the piriform cortex suggests posterior frontal and temporal subregions.
• Subregions of the piriform cortex have distinct connectivity profiles.
• Anterior PC extended into ventrotemporal PC posteriorly, which has not been described before, requiring further investigation.
• All parcellations were made publicly available.
Abstract
The anatomy of the human piriform cortex (PC) is poorly understood. We used a bimodal connectivity-based-parcellation approach to investigate subregions of the PC and its connectional differentiation from the amygdala.
One hundred (55 % female) genetically unrelated subjects from the Human Connectome Project were included. A region of interest (ROI) was delineated bilaterally covering PC and amygdala, and functional and structural connectivity of this ROI with the whole gray matter was computed. Spectral clustering was performed to obtain bilateral parcellations at granularities of k = 2–10 clusters and combined bimodal parcellations were computed. Validity of parcellations was assessed via their mean individual-to-group similarity per adjusted rand index (ARI).
Individual-to-group similarity was higher than chance in both modalities and in all clustering solutions. The amygdala was clearly distinguished from PC in structural parcellations, and olfactory amygdala was connectionally more similar to amygdala than to PC. At higher granularities, an anterior and ventrotemporal and a posterior frontal cluster emerged within PC, as well as an additional temporal cluster at their boundary. Functional parcellations also showed a frontal piriform cluster, and similar temporal clusters were observed with less consistency. Results from bimodal parcellations were similar to the structural parcellations. Consistent results were obtained in a validation cohort.
Distinction of the human PC from the amygdala, including its olfactory subregions, is possible based on its structural connectivity alone. The canonical fronto-temporal boundary within PC was reproduced in both modalities and with consistency. All obtained parcellations are freely available.
Highlights
• Northern and eastern grassland-savanna boundary defined by minimum temperature.
• Dynamics of fire, frost and growing season temperatures combine to produce this limit.
• Western limit is related to moisture availability.
• Modern, high-resolution climate data enables refinement of bioclimatic limits.
• Reparameterisation improves global model performance at regional scale.
Abstract
Understanding the controls of biome distributions is crucial for assessing terrestrial ecosystem functioning and its response to climate change. We analysed to what extent differences in climate factors (minimum temperatures, water availability, and growing season temperatures (degree days above 5 °C (GDD5)) might explain the poorly understood borders between grasslands, savannas and shrublands in eastern South Africa. The results were used to improve bioclimatic limits in the dynamic global vegetation model (DGVM) LPJ-GUESS. The vegetation model was also used to explore the role of fire in the biome borders. Results show no clear differences between the adjacent biomes in water availability. Treeless grasslands primarily occur in areas with minimum temperatures and GDD5 values below that of savannas. The standard fire module in LPJ-GUESS is not able to reproduce observed burned area patterns in the study region, but simulations with prescribed fire return intervals show that a combination of low temperatures and fire can explain the treeless state of the grassland biome. These results confirm earlier hypotheses that a combination of low winter temperatures, causing frost damage to trees, and low growing season temperatures that impede tree sapling growth and recruitment, particularly under re-occurring fires, drive the grassland-savanna border. With these insights implemented, the LPJ-GUESS simulation results substantially improved grass distribution in the grassland biome, but challenges remain concerning the grassland-shrubland boundary, tree-grass competition and prognostic fire modelling.
Purpose: To describe a novel surgical technique of a combined implantation of an artificial iris and a scleral fixated intraocular lens (IOL) using flanged IOL haptics (“Yamane” technique).
Observations: The suturelessly implanted artificial iris-IOL-sandwich was stable with good functional as well as aesthetic results. However, our case showed a postoperative intraocular pressure rise.
Conclusions: The presented case demonstrates that a visual as well as cosmetical rehabilitation seems to be possible even after severe, penetrating ocular trauma with profound iris defects.
Importance: The sutureless IOL scleral fixation technique can also be used in combination with a sutureless artificial iris implantation. Further studies are needed to evaluate the long-term safety profile and rates of postoperative complications.